Empire BlueCross BlueShield HealthPlus (Empire) Hot Tip: Allergies Your Empire patients on nonpreferred products may experience a pharmacy claim rejection. To avoid additional steps or delays at the pharmacy, consider prescribing preferred products whenever possible. Prior authorization and step therapy may apply to select preferred products. Coverage should be verified by reviewing the Preferred Drug List (PDL) on the Empire provider website. The PDL is subject to change quarterly. Therapeutic Nonpreferred products Preferred products class Cetirizine (generic Zyrtec) Fexofenadine (generic Allegra) Cetirizine/pseudoephedrine (generic Fexofenadine/ pseudoephedrine Zyrtec D) (generic Allegra-D) Zyrtec (cetirizine) Loratadine (generic Claritin) Zyrtec D (cetirizine/ Loratadine/pseudoepherine pseudoephedrine) (generic Claritin D) Clarinex (desloratadine) Oral Desloratadine (generic Clarinex) Antihistamines1 Alegra (fexofenadine) Allegra D (fexofenadine/ pseudoephedrine) Levocetirizine (generic Xyzal) Xyzal (levocetirizine) Claritin (loratadine) Claritin D (loratadine/ pseudoephedrine) Flonase Sensimist (fluticasone OTC budesonide nasal spray furoate) (generic Rhinocort) Flonase (fluticasone propionate) OTC Rhinocort Allergy Rx fluticasone propionate (generic (budesonide) Rx Flonase) OTC fluticasone propionate Mometasone furoate (generic (generic Flonase) Nasonex) OTC triamcinolone acetonide Nasacort (triamcinolone acetonide) (generic Nasacort) Nasal Steroids2 Nasonex (mometasone furoate) Omnaris nasal spray (ciclesonide) Qnasl (beclomethasone dipropionate) Rx triamcinolone acetonide (generic Rx Nasacort) Xhance (fluticasone propionate) Zetonna (ciclesonide) www.empireblue.com/nymedicaiddoc Empire BlueCross BlueShield HealthPlus is the trade name of HealthPlus HP, LLC, an independent licensee of the Blue Cross and Blue Shield Association. NYEPEC-2326-20 June 2020 Empire BlueCross BlueShield HealthPlus Hot Tip: Allegies Page 2 of 2 Therapeutic Nonpreferred products Preferred products class Alocril 2% (nedocromil sodium) Azelastine 0.05% Alomide 0.1% (lodoxamide Cromolyn 4% tromethamine) Epinastine 0.05% (generic Bepreve 1.5% (bepotastine besilate) Elestat) Elestat 0.05% (epinastine) OTC Ketotifen 0.025%4 Emadine 0.05% (emadastine (generic Zaditor) Ophthalmic difumarate) Anti-allergy3 Lastacaft (alcaftadine) Olopatadine eye drops (generic Patanol & Pataday) Pataday 0.2% (olopatadine) Patanol 0.1% (olopatadine) Pazeo 0.7% (olopatadine) Zaditor 0.025% (ketotifen 1 Approval of a non-preferred non-sedating antihistamine requires trial and failure of both a fexofenadine and loratadine-containing product. 2 Approval of a non-preferred nasal corticosteroid requires trial and failure of two preferred agents. Some exceptions apply. Please reference the online searchable formulary for full policy details. 3 Approval of a non-preferred agent requires trial and failure of all preferred ophthalmic anti- allergy agents. Some exceptions apply. Please reference the online searchable formulary for full policy details. 4 Ketotifen is only available as an OTC agent. Examples of product names include Alaway, Allergy Eye, Eye Itch Relief, Itchy Eye. If you have questions regarding this Hot Tip, call Provider Services at 1-800-450-8753. PDL: https://mediproviders.empireblue.com/ny/pages/formularies.aspx .